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(Stroke. 2001;32:579.)
© 2001 American Heart Association, Inc.

Comments, Opinions, and Reviews

Intravenous Unfractionated Heparin in Patients With Acute Ischemic Stroke: A Treatment to Be Used in the Context of Randomized Trials Only

Peter Sandercock, DM, FRCPE

From the Department of Medical Neurology, Western General Hospital, Edinburgh, UK.

	Introduction

 
There is no reliable evidence from randomized controlled trials to support the routine use of intravenous unfractionated heparin in acute ischemic stroke, yet this treatment is very widely used in the United States and elsewhere. The Collaborative Embolism Study Group trial included just 45 patients within 48 hours of stroke onset, and a study by Duke et al in 1986 included 225 patients with stable ischemic stroke.¹ Neither of these trials showed clear evidence of benefit. It seems quite extraordinary that clinicians continue to use this treatment in the absence of reliable data from randomized trial evidence: a triumph of opinion over evidence. A systematic review of the 21 completed randomized trials comparing different heparin regimes with control in acute ischemic stroke, including a total 23 427 patients, again failed to provide evidence of net benefit from unfractionated heparin, low-molecular-weight heparin, or heparinoid (the latter given either subcutaneously or intravenously).¹ There is also good evidence that the more intensive the heparin regime, the higher the bleeding risk.¹

This does not look promising as an evidence base for a new randomized controlled trial! On the other hand, there are thousands of clinicians worldwide who strongly believe in the benefit of intravenous heparin regimens in acute ischemic stroke; there are many more who do not. Dr Chamorro’s proposal for the RAPID randomized trial comparing intravenous heparin with aspirin may help to settle this therapeutic debate. The proposed trial is relatively small; for such a potentially important question it would ideally be an . . . [Full Text of this Article]

This article has been cited by other articles:

				H. P. Adams Jr Emergent Use of Anticoagulation for Treatment of Patients With Ischemic Stroke Stroke, March 1, 2002; 33(3): 856 - 861. [Abstract] [Full Text] [PDF]